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TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
. Location: A.M.� Lot Z� Zone of Contribution: In_ Out� Acreage .
Commercial: Residential: �
street: /� �� f°-D�� : �
Village�� / �lG GGCGI _ � F1oor Plan: 1� #Bedrooms:
pwner: ��Gf� /(/(/ �.�/'//L� Installer: �
Address: Phone:
Phone:
Builder: Engineer: /�� �� �
Address: Phone: � '�� Z S
Phone: ���C '/ cs- "'''a.%_� �14'✓
�o f� 7`_z i 'c.;` ' %�L'�!I
N/A YES NO
1.Re uired#of co ies received �
2. Date of soils exam and colation test not older than 2 ears L�
3. 4-5 ft of natural occurrin ervious material, above water table
4.Foundation 2 ft above hi oint of road H.P.: Fnd: Var.: `�
5. Water line 10 ft from s tic com onents Vaz.:
6. Benchmark indicated and shown-NGVD if near wetlands
7. S ric tank minimum 10 ft from foundation, deck Vaz.: ,/
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Vaz.: ', L��
9. Leachin minimum 100 ft from wetlands Var.: %
10.Leaching minimum 150 ft from drinkin wel]/25 ft irri tion well Var.:
11.Tank/leaching minimum 10 ft from ro e line Vaz.: �/
12. S stem meets all other setback r uirements Var.: {/'
13. Uses ad'ustmeirt for maximum high groundwater Var.: �/'
14.Leachin set 4-5 ft above ad�. water or bottom of test hole Vaz.: � i �
15. System not in to or subsoil(A,B horizons)or 5' removal ��
16.Pro sed comours aze suitable
17. S stem meets slo e r irements-min. 1/8", '/d' ef
18. System meets breakout re uirements P C liner: all:
19. S ec�ed tee sizes aze roper, gas baffle on outlet tee
20. Sewa e is under 10,000 d for arcel �/
21.No arba e dis osal
22. S stem ad uatel sized for its intended use ✓
. 23.Minimum 6"stone or com acted below tank and dbox
24.Manhole covers within 6"of e, um chamber cover to ade t�/
25. Ins ection port on plastic chambers/leach field ✓�
26. Electrical ermit for um chamber/Se azate meter for du lexes ;_/
27.Pum stem-2" line,wee hole,check valve, tee in dbozc, um size ��
28. S tic tauk/pum chamber to be factory wa roofed L/
29.Vent rovided if leachin below 3 feet, under driveway/pazkin �
30. Buo anc calculations for tank/pump chamber `�
31.En ' eer to ins ect and c soils: wall: commercial: �_
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32.Engineer/Registered Sanitarian and Land Surv or stam s/signature
33. H-201oadin is subject to vehicular traffic, groundwater
34. Title V A lication and ermit fee, installer si ture
35.Foundation footing min. 2 feet above ad'usted ound water for new house --
36. Deed Restriction re uired ma�c. #bedrooros: Z- max. flow: �_,v_: d
37. Check azea lots for oundwater/Label oundwater in Assessor's Ma
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Plan reviewed by: ��� wo�m3
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